Provider Demographics
NPI:1689210577
Name:JETER, NARI SUSAN (LMFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:NARI
Middle Name:SUSAN
Last Name:JETER
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2653
Mailing Address - Country:US
Mailing Address - Phone:850-765-6769
Mailing Address - Fax:
Practice Address - Street 1:1202 E PARK AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2653
Practice Address - Country:US
Practice Address - Phone:850-765-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3734106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT3734OtherMARRIAGE AND FAMILY THERAPY LICENSE